Healthcare Provider Details

I. General information

NPI: 1972435485
Provider Name (Legal Business Name): SUSAN RENE POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN RENE POWELL CMT

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CIVIC CT
CONCORD CA
94520-5553
US

IV. Provider business mailing address

1960 TREADWAY LN
PLEASANT HILL CA
94523-3312
US

V. Phone/Fax

Practice location:
  • Phone: 925-301-9179
  • Fax:
Mailing address:
  • Phone: 925-285-7807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: